Passionate pleas were made today at the State House on both sides of the debate over wehther Maine should expand Medicaid under the Affordable Care Act. Gov. Paul LePage vetoed a similar proposal last year, but there are some new elements added to this year's bill. Patty Wight reports.

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Maine Lawmakers Reconsider Medicaid Expansion

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This year's version of the Medicaid expansion bill has a so-called "sunset provision," and so would expire just before 2017, when federal matching funds drop from 100 percent coverage. It's designed to address the concern that Maine won't be able to afford the expansion once the state has to chip in money, and it also buys time to see whether the expansion is effective.

"What we have here in front of us is a compromise," said Democratic Senate President and bill co-sponsor Justin Alfond. Alfond says other compromises include requiring a co-pay from individuals who use the program, as well as establishing a fund to pool the savings accrued from accepting federal dollars.

Supporters say Medicaid expansion is an urgent need because nearly 25,000 Mainers lost coverage under MaineCare, the state's version of Medicaid, as of Jan. 1. The proposed bill would provide coverage to nearly three times that many Mainers, including Gayle MacLean, who testified before teh Health and Human Services Committee. MacLean owns Thread of the Mill Farm in Gray, where she boards horses, raises beef and chicken, breed dogs, and grows her own food.

"I was on MaineCare for a little over three years. It allowed me to do the work I needed to do, and know that if something happened to me I could get the care I needed," MacLean said. "Now, I'm tiptoeing around the farm, knowing if I get hurt or sick, I could lose my home and all that I have worked for all my life."

But Republicans say there are more fiscally prudent alternatives to expanding Medicaid. House Minority Leader Ken Fredette says about half of the 70,000 people who are eligible for the expansion currently qualify for subsidies on the Affordable Care Act's Online Insurance Marketplace.

"And most of them can buy policies for $4 to $10 dollars a week, and we think that's a viable alternative for people," Fredette says.

And Health and Human Services Commissioner Mary Mayhew warned the committee that Maine's current Medicaid program can't meet existing needs.

"When you are constantly bailing out the boat, when you are constantly trying to reestablish the crumbling financial foundation upon which this program today is built, you are not looking out more than six months down the road," Mayhew said.

When making the case for why the LePage administration opposes Medicaid expansion, Mayhew frequently points to the approximately 3,000 disabled Mainers who have been on a waiting list for years for MaineCare services. She says Maine should take care of these people before expanding health care for others.

But Sara Squires of the Disability Rights Center, who testified in favor of the expansion, says those are two separate issues.

"Expanding or not expanding MaineCare gets us no closer to addressing that problem," Squires said. "The federal dollars used to expand MaineCare cannot be used to fund people coming off the waiting list. And expanding MaineCare does not jeopardize the services currently in place for these individuals, nor does it prevent them from coming off the waiting list."

As for the 35,000 Mainers who qualify for both Medicaid expansion and insurance subsidies on the online marketplace, Consumers for Affordable Health Care's Mitchell Stein says the idea of having them buy insurance under the ACA doesn't fully consider the question of how those living just above the federal poverty level can afford the cost of co-pays.

"The bottom line is the human cost," Stein says. "And to say that someone at 101 percent of FPL, just because they are technically eligible for these subsidies, would be able to pay them, and pay the cost sharing, and be able to get the care they need, I think is unrealistic."

The task before Health and Human Services Committee members now, as one lawmaker put it, is to balance their responsibilities to the state budget and to Maine people, as they decide the issue of Medicaid expansion.